Healthcare Provider Details

I. General information

NPI: 1083348577
Provider Name (Legal Business Name): CHRISTOPHER LOUIS LORICH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 STRATHMORE CIR
MOUNT DORA FL
32757-8863
US

IV. Provider business mailing address

1645 STRATHMORE CIR
MOUNT DORA FL
32757-8863
US

V. Phone/Fax

Practice location:
  • Phone: 727-457-0833
  • Fax:
Mailing address:
  • Phone: 727-457-0833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberPSI41125
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: